FEMORAL CEMENTING TECHNIQUE FOR HIP RESURFACING ARTHROPLASTY: IMPORTANCE OF CEMENT APPLICATION

Abstract

Introduction: In recent retrieval studies over-penetration of cement, incomplete seating of the prosthesis with a resultant polar cement mass, or both, have been associated with femoral failures of current generation resurfacing arthroplasties. We developed a laboratory model to analyze differences in cement penetration, cement pressures and interface temperatures for hip resurfacing arthroplasty.

Materials and Methods: A carbon foam was demonstrated to closely simulate human femoral heads. Custom aluminum shells were made by DePuy with the same inner geometry as the femoral resurfacing components. (ASR™ system, Size 49, DePuy; Leeds, England).

Analyses of six different cementing techniques (cemtech) were performed using high viscosity (HVC) (Smart Set GHV, DePuy, Blackpool, England) and low viscosity cement (LVC) (Endurance, DePuy, Blackpool, England):

• Manual application HVC

• ¼filling of the component with LVC and manual appl.

• ¼filling HVC and manual appl.

• ½filling LVC

• ½filling HVC

• Complete filling with LVC

A force of 150N was used to press five shells in each cemtech group on foam specimens. During seating cement pressures and polymerization heat 5 mm under the foam surface were measured.

Specimens were cut into quarters, surfaces were digitalized and cement penetration areas and depths were quantified using a pixel-analysis-software. The effects of the cemtech were examined by Kruscal-Wallis and Mann-Whitney-U-tests (two-sided, p-value< 0.05, SPSS)

Results: The mean cement pressures increased going from cemtech A to E. HVC cemtech C and E showed higher pressures than the comparable LVC cemtech B and D.

Maximum temperatures were A) 36.0± 4.1°C, B) 45.0±5.7°C, C) 36.2±4.2°C, D) 53.5±2.5°C, E) 48.3±6.5°C and F) 53.2±12.6°C. D, E and F exceeded 50°C.

A provided even cement penetration over the available fixation area without involvement of the internal area and the stem. Cemtech that used LVC cement (B, D and F) showed higher interior area cement contents than HVC (A, E and C). The cement content in the interior area was A) 39.3±26.4mm2, B) 72.1±16.9mm2, C) 37.7±10.5mm2, D) 99.0±24.6mm2, E) 67.5±15.6mm2 and F) 121.0±29.0mm2.

A showed mainly complete seating with a cement mantle thickness of 0.5±0.7 mm. All other cemtech had incomplete seating in all specimens with significantly thicker polar cement mantles (p=0.032) up to a maximum of 4.6±1.2mm for E.

Discussion: Component filling cemtech and LVC resulted in variable degrees of over-penetration, exposure to high temperatures or a risk for incomplete seating, which have been associated with bone necrosis and early fracture. The use of the manual application and HVC cement showed clear advantages in our model. It was possible to utilize all of the available fixation area without negative effects.